Predictive Clinical and Surgical Factors Associated with Recurrent Apoplexy in Pituitary Adenomas.

 Pituitary apoplexy is an uncommon clinical condition that can require urgent surgical intervention, but the factors resulting in recurrent apoplexy remain unclear. The purpose of this study is to determine the risks of a recurrent apoplexy and better understand the goals of surgical treatment.  A retrospective chart review was performed for all consecutive patients diagnosed and surgically treated for pituitary apoplexy from 2004 to 2021.

Cranial floor fracture: A growing orbital roof fracture with encephalocele - Case Report.

Orbital roof fractures are among the rarest of craniofacial fractures. The mechanism of injury is typically a high-impact blunt force vector directly to the orbit or forehead. Most patients are males between 20 and 40 years old, involved in motor vehicle accidents.

Quantitative determination of the optimal temporoparietal fascia flap necessary to repair skull-base defects.

Background: The ability to reconstruct large cranial base defects has greatly improved with the development of pedicled vascularized flaps. The temporoparietal fascia flap (TPFF) is a viable alternative to the Hadad-Bassagasteguy nasoseptal flap for large ventral skull-base defects. This study aims to characterize the size of the TPFF necessary for optimal ventral skull-base reconstruction.

Endoscopic Transnasal Transclival Approach to a Pontine Cavernoma with Associated Developmental Venous Anomaly.

Background: Brainstem cavernous malformations represent around 8%-22% of all intracranial cavernous malformations but exhibit a higher annual incidence of hemorrhage (2%-3%) compared with other cavernous angiomas and tend to be more symptomatic given their proximity to critical nuclei and fiber tracts. Recently, endoscopic endonasal techniques have been used for the removal of ventral skull base lesions, with significant improvement in operative morbidity and mortality compared with open approaches. Here we demonstrate the utility and feasibility of the endoscopic transclival approach for ventrally located pontine cavernomas in carefully selected patients.

Creating a Culture of Collaboration: A Brief History of Academic Neurosurgery in Washington, DC.

Clinical neurosurgery has been practiced in the US capital for just over 100 years. As former residents and fellows of Drs. Harvey Cushing and Walter Dandy moved to the region, hospitals at Georgetown and George Washington Universities became early adopters of this new surgical discipline.

Comparison of posterior fossa volumes and clinical outcomes after decompression of Chiari malformation Type I.

OBJECTIVE Previous studies have indicated an association of Chiari malformation Type I (CM-I) and a small posterior fossa. Most of these studies have been limited by 2D quantitative methods, and more recent studies utilizing 3D methodologies are time-intensive with manual segmentation. The authors sought to develop a more automated tool to calculate the 3D posterior fossa volume, and correlate its changes after decompression with surgical outcomes.

Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas.

Objective: To assess outcomes after endoscopic endonasal surgery for recurrent or residual pituitary adenomas.

Methods: We retrospectively analyzed 61 patients from 2009 to 2016 who underwent endoscopic endonasal surgery for recurrent or residual pituitary adenomas after previous microscopic or endoscopic transsphenoidal operation.

Results: The previous surgical approach was endoscopic endonasal in 55.

A Cost Analysis of Regional Versus General Anesthesia for Carotid Endarterectomy.

Background: Medical care in the United States has evolved into a more cost-conscious value-based health care system that necessitates a comparison of costs when there are alternative interventions considered to be acceptable in the treatment of a disease. This study compares the cost differences between regional anesthesia (RA) and general anesthesia (GA) for carotid endarterectomy (CEA).

Methods: Data from 346 consecutive patients who underwent CEA between January 2012 and September 2014 were retrospectively reviewed for the type of anesthesia used, outcomes data, and cost variables.

High-grade glioma with anterior skull base erosion and intranasal extension: case report.

The authors describe the case of a large WHO Grade III anaplastic oligoastrocytoma extending through the anterior skull base and into the right nasal cavity and sinuses. Glial neoplasms are typically confined to the intracranial compartment within the brain parenchyma and rarely extend into the nasal cavity without prior surgical or radiation therapy. This 42-year-old woman presented with progressive headaches and sinus congestion.

Spatial and temporal homogeneity of driver mutations in diffuse intrinsic pontine glioma.

Diffuse Intrinsic Pontine Gliomas (DIPGs) are deadly paediatric brain tumours where needle biopsies help guide diagnosis and targeted therapies. To address spatial heterogeneity, here we analyse 134 specimens from various neuroanatomical structures of whole autopsy brains from nine DIPG patients. Evolutionary reconstruction indicates histone 3 (H3) K27M--including H3.

Differential Effects of Cold Atmospheric Plasma in the Treatment of Malignant Glioma.

Objective: Cold atmospheric plasma (CAP) has recently been shown to selectively target cancer cells with minimal effects on normal cells. We systematically assessed the effects of CAP in the treatment of glioblastoma.

Methods: Three glioma cell lines, normal astrocytes, and endothelial cell lines were treated with CAP.

Use of cold atmospheric plasma in the treatment of cancer.

Cold atmospheric plasma (CAP) is an emerging modality for the treatment of solid tumors. In-vitro experiments have demonstrated that with increasing doses of plasma, tumor cells assays display decreased cell viability. CAP is theorized to induce tumor cells into apoptosis via multiple pathways including reactive oxygen and nitrogen species as well as cell cycle disruption.

Acute management of military-related injury.

Since the dawn of armed conflict head trauma has remained one of the most challenging afflictions for surgeons and medical personnel to treat. Interventions for head trauma from antiquity through the American Civil War were met with dismal outcomes. In the 20th century, despite greater lethality of weapons, progressive advances in management led to improved outcomes for head injured patients.

Intracranial injectable tumor model: technical advancements.

Background and Objectives Few simulation models are available that provide neurosurgical trainees with the challenge of distorted skull base anatomy despite increasing importance in the acquisition of safe microsurgical and endoscopic techniques. We have previously reported a unique training model for skull base neurosurgery where a polymer is injected into a cadaveric head where it solidifies to mimic a skull base tumor for resection. This model, however, required injection of the polymer under direct surgical vision via a complicated alternative approach to that being studied, prohibiting its uptake in many neurosurgical laboratories.

Spindle cell hemangioendothelioma of the sacrum: case report.

Spindle cell hemangioendothelioma is a rare benign vascular tumor that is not known to involve the sacrum. The authors describe the case of a 31-year-old woman presenting with low-back and radicular pain without weakness or bowel or bladder dysfunction. Admission CT and MRI studies revealed a large S1-3 lytic sacral lesion.

Unilateral coronal craniosynostosis and Down syndrome.

There is no known correlation between Down syndrome and craniosynostosis. The authors report 2 infants with trisomy 21 and right unilateral coronal craniosynostosis. Both patients were clinically asymptomatic but displayed characteristic craniofacial features associated with each disorder.

Association of cerebellopontine angle atypical teratoid/rhabdoid tumors with acute facial nerve palsy in infants.

Atypical teratoid/rhabdoid tumors (AT/RTs) are highly malignant CNS tumors found almost exclusively in childhood. Although essentially universally fatal when incompletely resected, prompt diagnosis followed by early chemoradiation can improve outcomes. An AT/RT can occur extraaxially at the cerebellopontine angle (CPA) and cause acute cranial nerve deficits as the presenting sign.

Sorafenib tosylate as a radiosensitizer in malignant astrocytoma.

Progress in research on the molecular aspects of glioblastoma has yet to provide a medical therapy that significantly improves prognosis. Glioblastoma invariably progress through current treatment regimens with radiotherapy as a key component. Activation of several signaling pathways is thought to be associated with this resistance to radiotherapy.

Successful endoscopic repair of persistent cerebrospinal fluid leak following attempted transcranial repair.

Endoscopic techniques have become the preferred approach to address cerebrospinal fluid (CSF) leaks in the skull base, as they offer a minimally invasive method to directly visualize and repair the defect. The alternative technique of open craniotomy can still be considered for cases refractory to endoscopic repair; however, few studies have investigated the potential benefits of endoscopic repair for cases of persistent leaks after attempted transcranial repair. We report two such cases of successful long-term endoscopic repair of a persistent CSF leak, and demonstrate that endoscopic repair is a viable option to salvage an unsuccessful intracranial repair.

NOS-2 signaling and cancer therapy.

The role of NO and cGMP signaling in tumor biology has been extensively studied during the past three decades. However, whether the pathway is beneficial or detrimental in cancer is still open to question. We suggest several reasons for this ambiguity: first, although NO participates in normal signaling (e.

Relapsed acute myelogenous leukemia of brachial plexus after marrow transplant.

We present a detailed description of brachial plexus infiltration by acute myelogenous leukemia (AML) in the setting of a remission bone marrow biopsy, without evidence of leukemia by flow cytometric analysis. This case illustrates the possibility of dormant leukemic cells in the peripheral nervous system (PNS) in a patient in apparent clinical remission. In patients with an unexplained brachial plexopathy and a history of AML, leukemic infiltrate of the PNS must be considered.

Radiation necrosis following treatment of high grade glioma--a review of the literature and current understanding.

Radiation therapy is an integral part of the standard treatment paradigm for malignant gliomas, with proven efficacy in randomized control trials. Radiation treatment is not without risk however, and radiation injury occurs in a certain proportion of patients. Difficulties in differentiating recurrence from radiation injury complicate the treatment course and can compromise care.

Rapid improvement of cranial neuropathies after endoscopic resection of sphenoid sinus mucocele.

Sinus mucoceles are benign, slowly enlarging, mucous-secreting, cystic lesions whose expansile growth may lead to compressive neuropathies. We present the case of a 70-year-old woman with a long-standing history of headaches and progressive ocular neuropathy who underwent an endoscopic resection of a large sphenoid sinus mucocele resulting in immediate improvement of her neurological symptoms. The endoscopic endonasal transsphenoidal approach offers a minimally invasive method to manage and treat symptomatic sinus mucoceles.

Frequency and causes of combined obstruction and restriction identified in pulmonary function tests in adults.

Background: The frequency of combined obstruction and restriction identified in pulmonary function tests has not been well described. Moreover, although the causes of combined-obstruction-and-restriction patterns are known, the frequency of the various etiologies has received little attention.

Methods: We retrospectively reviewed medical records and surveyed pulmonologists.